ENT Flashcards
What is the watershed area of the vascular supply to the nose?
Kiesselbach’s plexus
This is the area in the anterior part of the nasal septum where the branches of the labial, sphenopalatine, and ethmoidal arteries meet.
How often are tracheostomies changed?
Children have a one-piece canula and it is changed weekly.
Adults have a stoma piece that is changed every two months and a canula that is changed weekly.
Dysphonia (hoarseness) and palpable neck emphysema in a trauma patient suggest what diagnosis?
Laryngeal fracture
Unilateral submandibular swelling can be caused by ____________-lithiasis.
sialo
Stones in the salivary ducts can be seen on POCUS or CT.
When is cleft lip usually repaired?
10 weeks of life
What are indications for urgent endoscopy to remove stuck objects in the throat?
Difficulty swallowing
Inability to swallow secretions
Respiratory distress
Why is it important to identify and drain septal hematomas?
The cartilage of the nose (including the septum) is avascular. Its blood supply is provided by the perichondrium. Septal hematomas are usually hematomas underneath the perichondrium and above the cartilage. The hematoma can lead to ischemic necrosis of the septum.
What percent of rhinosinusitis is caused by bacteria?
0.5 - 2.0 %
What is the top rim of the ear called?
The helix
What is the name of the little piece of tissue that sticks out of the meatus of the ear from the anterior rim of the ear?
The tragus
For post-piercing infections, you need to cover for _____________.
Pseudomonas aeruginosa
Review the management of suspected tracheoarterial fistula.
1) Overinflate the balloon to attempt tamponade
2) Secure airway with orotracheal intubation
3) Remove tracheostomy tube
4) Digitally compress artery with finger against sternum
What two atomized medications can you give to refractory epistaxis?
Afrin and TXA
If a person with a live insect in the ear has a lidocaine allergy, what else can you use to kill the insect?
Mineral oil
Do not irrigate the ear if you are concerned that ___________________.
the ear drum might be perforated
The part of the jaw that is anterior to the condyle is the ______________.
coronoid process
The coronoid process and condyle join together at the ramus. The ramus leads to the angle. The angle leads to the body and ultimately to the symphysis.
Which bones of the face is least likely to fracture?
Frontal
If you remove a foreign body from the ear canal and there are abrasions in the canal afterwards, be sure to __________________.
prescribe 2-3 days of ciprofloxacin otic drops at discharge
Which types of LeFort fractures can affect the cerebrovasculature?
II, III, and IV
Review the zones of the neck.
Zone I: clavicles to cricoid cartilage
Zone II: cricoid cartilage to mandible
Zone III: mandible to skull base
The most common serious complication of Ludwig’s angina is what?
Sudden asphyxiation from edema
Trismus, fever, nuchal rigidity, muffled voice, and pain with neck extension suggest what?
Retropharyngeal abscess (in the prevertebral fascia)
How does posterior epistaxis present?
Heavy bilateral bleeding from both nares and posterior bleeding noted
Rhino rockets should be coated in ____________ in treating patients on anticoagulation.
TXA
Rhino rockets should be removed in _______ hours.
72
What are three complications of Ludwig angina?
IJ thrombosis, mediastinitis, and meningitis
Posterior epistaxis most commonly arise from bleeding in which vessel?
Sphenopalatine artery
The lateral neck radiograph for evaluating for retropharyngeal abscess should be done how?
With the neck in extension (tilting head back) at end inspiration
Flexing the neck expands the retropharyngeal space and leads to higher false positives. Likewise, exhaling also expands the space.
Why are children younger than 4 more prone to retropharyngeal abscess?
There are retropharyngeal lymph nodes that involute after age 4. They are prone to infection.
In the Rinne test, air conduction is supposed to be _________ than bone conduction.
better
You first have the tuning fork on the mastoid. When they can’t hear it any more put the fork next to the auditory meatus. If they can’t hear it, it suggests conductive hearing loss.
What are the indications for draining an auricular hematoma?
Recent (less than 7 days) bleed that deforms the pinna
After draining an auricular hematoma, always _______________.
do a pressure dressing to prevent reaccumulation
What is the most common pathogen that causes bacterial tracheitis?
S. aureus
True or false: purulent nasal drainage is a sign of bacterial rhinosinusitis and warrants urgent antibiotics.
False
Viral rhinosinusitis can also cause purulent drainage.
What is the duct called that carries saliva to the area near the frenulum?
Wharton duct
What pressure should ETT tubes be set at?
20-30 cm H2O
Expiratory stridor in a person with a recent history of prolonged intubation is likely ______________.
acquired tracheomalacia
The carotid sheath lies _____ posterolateral to the tonsil.
2.5 cm
What is the sensitivity of lateral neck X-ray for epiglottitis?
88%
True or false: nasal septal hematoma should be drained with needle aspiration.
False
Needle aspiration cannot evacuate clots. I&D is preferred.
What technique is needed for a lateral neck xr for r/o RPA?
Extension and inspiration
Flexing forward and exhaling cause the pharynx to relax which makes it difficult to see abnormal soft tissue swellings.
Criteria for RPA on XR?
7 mm at C2, 14 mm at C6
What does bacterial tracheitis show on lateral x-ray?
Irregular densities on the trachea
Epiglottitis with no difficulty swallowing is likely what etiology?
Bacterial tracheitis
With nasal bone fracture, what three things can be emergencies that require reduction and/or other manipulation?
CSF leak (suggesting occult basilar skull fracture)
Uncontrolled epistaxis
Occlusion of one or both nares
What is a tripod fracture and why is it important?
A tripod fracture occurs when the supports to the lateral cheekbone (the zygoma, the maxilla, and the lateral orbit) are all fractured. This is important because they are operative. They need stabilization or the face will be asymmetric.
Which bone is fractured in CSF rhinorrhea?
Ethmoid
What is the treatment for simple and complex aphthous stomatitis?
Simple (short course, few lesions): topical steroids
Complex (long course, recurrent, many lesions): PO steroids
True or false: the corner of the jaw is the mandibular ramus.
False
The corner of the jaw is the mandibular angle. The ramus is superior to the angle, beneath the condyle (posterior) and cornoid (anterior).
Which facial fractures are associated with infraorbital anesthesia?
Inferior orbital wall
True or false: if you see active bleeding in the nose then cautery is the first-line treatment.
False
Oxymetazoline is always first line.
What is a cholesteatoma?
A mass of keratinized epithelium in the middle ear
What is the narrowest part of the esophagus?
The cricopharyngeus muscle, which is at the level of C6
The cricopharyngeus muscle is also called the inferior pharyngeal constrictor. There are superior and middle pharyngeal constrictors that all work to push food down.
Which is more associated with AOM, bulging or opacification of the TM?
Bulging
Opacification can occur with effusion.
Is age-related presbycusis conductive or sensorineural?
Sensorineural (“SENile = SENsorineural”)
